Studies link le­gal mar­i­juana with fewer opi­oid pre­scrip­tions

South Florida Times - - HEALTH - By AP Science Writer Le­gal Mar­i­juana

MAL­COLM RIT­TER

NEW YORK (AP) _ Can le­gal­iz­ing mar­i­juana fight the prob­lem of opi­oid ad­dic­tion and fatal over­doses? Two new studies in the de­bate sug­gest it may.

Pot can re­lieve chronic pain in adults, so ad­vo­cates for lib­er­al­iz­ing mar­i­juana laws have pro­posed it as a lower-risk al­ter­na­tive to opioids. But some re­search sug­gests mar­i­juana may en­cour­age opi­oid use, and so might make the epi­demic worse.

The new studies don't di­rectly assess the ef­fect of le­gal­iz­ing mar­i­juana on opi­oid ad­dic­tion and over­dose deaths. In­stead, they find ev­i­dence that le­gal­iza­tion may re­duce the pre­scrib­ing of opioids. Over-pre­scrib­ing is con­sid­ered a key fac­tor in the opi­oid epi­demic.

Both studies were re­leased Mon­day by the jour­nal JAMA In­ter­nal Medicine.

One looked at trends in opi­oid pre­scrib­ing un­der Med­i­caid, which cov­ers low-in­come adults, be­tween 2011 and 2016. It com­pared the states where mar­i­juana laws took ef­fect ver­sus states with­out such laws. The com­par­i­son was done each quar­ter, so a given state with­out a law at one point could join the other cat­e­gory once a law kicked in.

Re­sults showed that laws that let peo­ple use mar­i­juana to treat spe­cific med­i­cal con­di­tions were as­so­ci­ated with about a 6 per­cent lower rate of opi­oid pre­scrib­ing for pain. That's about 39 fewer pre­scrip­tions per 1,000 peo­ple us­ing Med­i­caid.

And when states with such a law went on to also al­low recre­ational mar­i­juana use by adults, there was an ad­di­tional drop av­er­ag­ing about 6 per­cent. That sug­gest the med­i­cal mar­i­juana laws didn't reach some peo­ple who could ben­e­fit from us­ing mar­i­juana in­stead of opioids, said He­fei Wen of the Uni­ver­sity of Ken­tucky in Lex­ing­ton, one of the study au­thors.

The other study looked at opi­oid pre­scrib­ing na­tion­wide for peo­ple us­ing Medi­care, which cov­ers peo­ple 65 years or older and those with dis­abil­i­ties.

Every year from 2010 through 2015, re­searchers com­pared states with a med­i­cal mar­i­juana law in ef­fect to those with­out one. Four­teen states plus the District of Columbia had such a law from the be­gin­ning of that time; nine other states joined them dur­ing the years the study cov­ered.

Re­searchers found that Medi­care pa­tients in states with mar­i­juana dis­pen­saries filled pre­scrip­tions for about 14 per­cent fewer daily doses of opioids than those in other states. Pa­tients in states that only al­lowed them to grow pot at home showed about 7 per­cent fewer doses.

W. David Brad­ford, an econ­o­mist at the Uni­ver­sity of Ge­or­gia in Athens who's an au­thor of the sec­ond study, said the re­sults add to other find­ings that sug­gest to ex­perts that mar­i­juana is a vi­able al­ter­na­tive to opioids. The weight of that ev­i­dence is “now hard to ig­nore,'' said Brad­ford, who said he thinks fed­eral reg­u­la­tions should be changed to al­low doc­tors to pre­scribe mar­i­juana for pain treat­ment.

The two studies have some lim­i­ta­tions, Dr. Kevin Hill of Har­vard Med­i­cal School and Dr. Andrew Saxon of the Uni­ver­sity of Wash­ing­ton in Seat­tle wrote in an ac­com­pa­ny­ing ed­i­to­rial.

For one thing, they don't re­veal whether in­di­vid­ual pa­tients ac­tu­ally re­duced or avoided us­ing opioids be­cause of the in­creased ac­cess to mar­i­juana. The find­ings in Med­i­caid and Medi­care pa­tients may not ap­ply to other peo­ple. And the re­sults may have been skewed by some char­ac­ter­is­tics of the state pop­u­la­tions stud­ied, they wrote. They called for states and the fed­eral gov­ern­ment to pay for more studies to clar­ify the ef­fect of mar­i­juana use on opi­oid use, say­ing such re­search is needed for science to guide pol­icy-mak­ing.

PHOTO COUR­TESY OF CIV­I­LIZED.LIFE

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